Living life and figuring it out, one little piece at a time

Thursday 19 January 2012

What my first two weeks of Normal Childbearing looked like

Okay, so I've been facing lots of pressure to get some blog posts up  here!  Sorry to anyone who may have been  itching to know what placement was like...I was too, until a couple weeks ago when it started.  But suffice to say that my absense in posting is because placement is VERY BUSY!  I am going to try and make this post as thorough as possible but please know I might not post again until close to the end of term.  This is the one-stop shop, "Heres what a couple of weeks in placement looks like"

Disclaimer:  As I'm sure you understand, I have to maintain full confidentiality of all clients.  I can't give any details that might reveal dates, names or any form of detail that could identify someone.  Therefore I'm trying to remain extremely vague about my experiences.

In our Normal Childbearing placement, which is 16 weeks in duration, we must attend a minimum of 18 births and a maximum of 30.  There is variation due to the nature of the clinic workings, but also  because we need to act as primary midwife for some of those births, second midwife for some, and are allowed only a small number of observed births (2).  Since all women who need oxytocin IV or epidurals are transferred out of our care and we can't conduct the birth (to a certain extent), there will inevitably be more than two observed births.  Therefore I anticipate nobody could really make all their other necessary numbers with only 18 births.  We're expected to be on call for these births at all times, aside from 4 days per month and every Friday morning for tutorial. 

Anyway, on top of the births, we are supposed to attend 15 pre- or post-natal visits per week.  This is also something very variable, since some practices have 15-30 minute appointments and can get 15 clinic visits into one or two days.  My practice's appointment times are 45 minutes - *such* a treat to have the time to spend with the women, but definitely a bigger challenge to get those numbers in.  I've only successfully gotten an entire 15 visits in one of the three weeks I've been there, and I've attended every single visit I could, unless I've been at a birth. 

In addition to the clinical duties, we have tutorial duties.  The PBL format that I hopefully described about Repro from last semester is used for the rest of the duration of the programming at the MEP - so we're given a situation and we have to extract issues from the situation and go out and learn about them to teach eachother at the next tutorial.  Therefore, we need to prepare each week a presentation to share what we learned about the topic that we were to work on for that week.  In addition to that, we have to present an informed choice discussion on a basic pregnancy intervention (testing, etc), write a couple of papers about learning issues, create learning plans, write midterm and final exams, and probably some other things that I'm not aware of yet.  Realistically, it doesn't look THAT heavy to me at this point.  The academic load seems similar to that of ONE course - which is very fortunate since the clinical side of things feels equivalent to 7 or 8.  We are also required to have a reserved half-day each week during business hours to work on our assignments.  So far, I've been able to keep my assignment obligations within that half day, but I'm sure there'll be weeks where its not enough.

By the end of the term, we are expected to have attended our required births and clinic visits, and to have exhibited basic skill in all areas of caring for normal, healthy pregnant women and their babies.  This is a very diverse thing to accomplish, I have learned.  Midwifery is a dynamic profession that requires creativity and an open mind at all times.  This was probably my first lesson. 

My first day in placement was lovely - an orientation of sorts.  I joined the group for their practice meeting and got to meet a lovely set of women who work together to create the web of midwifery care that this clinic provides.  This particular practice is split into two teams - the team I'm working with has approximately 22 births from the time I started until the end of my placement, but they also back-up the other team, which probably has an equal number of births planned.  Before I realized that my team attends all the births in the clinic (and I would be expected to do the same), I was concerned that if I missed any on my day off, I might not make my numbers.  Now I'm starting to wonder if I might need to taper the numbers down close to the end of the term as I might hit my maximum.

My first weeks have been busy. I live a good distance from my practice, which is in a pretty rural setting.  This means that it takes me at least 45 minutes to get to clinic every day, and the home and hospital visits we do for our new mothers after birth can involve one heck of a commute, since this practice serves an enormous catchment area.  Not one word of a lie, I have had days where I've covered almost 600km.  And please, let me allow you to think about what it is like to drive the hour to get home, and then get paged right back (especially if its right after a long birth).  I also can't begin to describe how hard it is to come home at 1am and leave again at 6am, only to return home at 10pm.  I've gone days without seeing my kids or partner.  Ladies anticipating placement or considering the program, let it be known that there is blood, sweat, and tears involved in this profession, and they're not only coming from birthing mothers.  I could NOT get through days like those without rock solid support (and I mean it, undending, unconditional support), good nutrition available at all times, and a plan to make sure I get sleep at some point in the next day or two.  ALL of those things wouldn't be anywhere near within my reach if it weren't for the fact that my partner is pretty much putting his career on hold and acting as stay at home dad.  He's cooked almost every day, taken the kids away when its necessary, put them to bed almost every night, washed most of the dishes and laundry, gotten our daughter off to school every morning, and cared for our son on his days home as well.  There is no way I'd be able to do this without him. 



So really, I shouldn't complain.  I knew what I was getting myself into when I signed up for a practice so far away from me, but I also knew the philosophies of these midwives and I wanted very much to be influenced by their practices.  I can't say enough good things about my preceptors.  Its definitely a challenge having two who have two different teaching styles, schedules, and expectations for me, but its an awesome privilege to glean the best from both of these wonderful, caring midwives. 

 There's so much learning to be done in the clinic days.  I feel so awkward in those visits.  Its such a privilege to be sitting in on them.  The fact that these midwives are opening their clients up to me, and that these clients are opening themselves up for my learning, is a real gift.  I definitely feel pretty stupid most of the time though.  I know most of what is being said in the visits, but I almost never remember it when everyone turns to me and says "Do you have anything to add?".  I usually remember lots to say AFTER, though, so at least its coming at some point.  I need to start writing out scripts for various discussions that take place so that eventually I can take over the midwife's side of the conversation and begin teaching and learning from the client more directly.  That process, here in my third week of placement, is starting.  Very slowly, but its starting.

So what do we do with women aside from talking?  Everything I learned in clinical skills has been put to the test aside from one or two that I've chickened out on so far (I chickened out on IV insertion, and I havent' had a chance to do a Pap).  I've already had ample opportunities to feel bellies, measure fundal height, take blood pressure, listen to the babies heart, draw blood, do injections, perform cervical exams, break membranes in labor, catch babies (!! with the help of my preceptors), catch placentas, suture, assess the newborn, administer vitamin K and erythromycin to the newborn, provide breastfeeding support (or rather, mostly observe my awesome preceptor giving her breastfeeding support), and probably a hundred more things that I can't even think of.  I've also been witness to a number of complications in labor and birth.    As I said - very diverse!!  Never a dull day. 

Bearing in mind that this has all been within the 17 days that I have been in placement - - lots of clinic days, and SIX births already.


The last thing that I mentioned in the list were pretty hard to swallow.  As much as I have learned from some of these complicated  births, they weren't exactly typical examples of "Normal Childbearing".  I have to admit that, just as I had feared might happen, my faith in the process has definitely been put to the test and I've found myself wondering at a birth what will go wrong at this one.  I used to loathe this in birth professionals when I was a mother.  I wanted someone with utmost confidence in me.  And I still have utmost confidence in women.  But now that I've been on the other side of the fence, I've begun to understand that by putting your utmost faith into your midwife or attending physician, the mother (or the doula, in my case) is able to release most of the fear of complications that surround childbirth.  But those risks don't go away just because you let go of the fear - you've just got someone well equipped to handle them if they come along.  Stepping into the place of someone who is learning how to be responsible for handing those risks is a heavy burden and an enormous privilege.  It brings me a new sense of purpose to the profession.  It also, sadly, makes me realize that I cannot prevent every unnecessary intervention put upon a mother or her baby, because sometimes we don't know if an intervention is necessary or not, but only that it lowers risk.

ANYWAY!  As you might be able to tell, my thoughts are scattered and my brain is tired.  The last couple of days there have been no births, and I have been thankful for the chance to catch up on sleep and gain my brain back. 

And now, its 10pm, and I'm probably committing suicide by staying up so late!

3 comments:

  1. I really enjoy reading about your journey, and appreciate hearing what it is like on the 'other side', even though it's a bit scary for me reading it while currently pregnant! I admire your dedication so much and am in awe of what you're going through right now. I could never do it! Best of luck for the remainder of your time in clinic. I saw your poster when I had my appointment yesterday, and though I am on the other team, maybe we will get a chance to meet. Thanks for sharing and all the best!

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  2. Wow...Thank you for your honest (and I'll admit, sobering...) post. It's great to hear the student's perspective and how you are managing a midwife's schedule and way of life. Awesome that you have such an able and willing partner!

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  3. Where did you go? I am so curious. I am trying to decide where to go and I'd like a rural placement with not too many students. I am thinking of Stratford or Fergus.

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